Doctors from St. Jude Children’s Hospital report that their treatment for acute lymphoblastic leukemia cures as many African American children as white children. In their article, published in the Journal of the American Medical Association (Vol. 290, No. 15: 2001-2007) they report a cure rate of around 80% for both groups.

Although treatment for leukemia in children has improved from a 15% cure rate in the 1960s to the 80% seen in this study, the results in black children overall have not kept pace with those in white children. In the same issue of the journal, researchers led by Nina Kadan-Lottick, MD, of Yale University, report that in the country as a whole, 5-year survival rates were only 75% for African American children with acute lymphoblastic leukemia compared with 84% for white children. Their information came from the National Cancer Institute’s SEER program, which is the nation’s cancer registry.

Both the St. Jude researchers and Kadan-Lottick report that the cure rate for both groups improved in successive decades from the 1960s, though African American children fared worse than white children. But at St. Jude, the researchers, led by Ching-Hon Pui, MD, noted that between 1984 and 1992, their cure rate for black children was nearly the same as that for white children; and in the period from 1992-1998 the rates became equal.

What accounts for these differences? According to William Carroll, MD, a pediatric oncologist who wrote an editorial about these articles, one factor may be that all the St. Jude children were enrolled in clinical trials. He says participation in clinical trials ensures that all children receive the most advanced treatment. He adds that black children have a much lower rate of participation in these trials than whites.

Another factor is adherence to treatment. Not all children and parents follow-up with their doctors properly. In the St. Jude population no patients were lost to follow-up during treatment.

Another factor may be health insurance. St. Jude treats all children at no cost to the family. Problems with insurability, co-pays and deductible payments might impede treatment outside such a generous system.

Finally, Carroll points out that the St. Jude doctors used a more aggressive treatment regimen than do most institutions. This may have been helpful to some children whose leukemia might have been more resistant to standard treatment. In fact, many of the black children in the St. Jude study had disease characteristics that gave them a poorer prognosis than the white children, yet they fared equally well.

The difference in outcomes between black and white children with acute lymphoblastic leukemia can be eliminated, say the St. Jude researchers. Patients need to receive therapy regardless of their insurance status or ability to pay, and be followed by the same team of experienced caregivers, which ensures optimal compliance with therapy, they say.